PARAMEDICS are wasting thousands of hours stuck outside hospitals when they could be responding to other 999 calls, the Echo has learned.

Ambulance staff have lost more than 7,000 working hours in four months due to handover delays at hospitals in the region.

Figures from South Western Ambulance Trust show that ambulances regularly wait over 30 minutes to transfer patients, losing more than 60 hours per day every day from May to August.

This is despite a delay of just 15 minutes being labelled 'zero tolerance' by the NHS.

In two cases between April and August, patients were left waiting to be transferred to hospital for more than two hours; five were waiting three to four hours and seven two to three hours. 

It means that patients are potentially waiting longer for an ambulance when they call 999 because paramedics are tied up in a queue outside A and E departments.

In August, the latest reported month, 20 per cent of 'red' category patients– those in the most serious condition– waited up to 32 minutes for an ambulance.

Twenty–per cent of 'amber' category patients, where a blue light emergency response is required due to 'potentially serious condition' waited up to 87 minutes for a response.

But this is a slight improvement– in March they lost 2,609 hours; an increase of 104 per cent year on year.

During that month, the trust reported a small number of category-A patients waiting more than 108 minutes for a response.

Richard Drax, MP for South Dorset, yesterday asked the Secretary of State for Communities and Local Government to make ambulances and A&E funding a priority, while re-examining how the NHS is run.

Speaking during an adjournment debate, which he had called, on ambulance waiting times, Drax said, “We really ought to think about the whole NHS and how it is run, not just the ambulance service. We need to do that free of politicians, with expert advice being sought from non-politicians—those who know how the health system works, not least the clinicians—so that we can re-look at this whole situation. We have enough money, but we have not spent it particularly wisely in every case.”

NHS targets were exacerbating the problems, Drax said, “with not a single one of the 10 ambulance trusts in England meeting the target of reaching 75% of incidents within eight minutes.”

Handovers at hospital frequently breach the 30-minute target handover time, said Drax, incurring fines and increasing the pressure on cash strapped trusts. “Yet, handovers can be achieved only if there are available beds and bays in the emergency department, which in turn can free up space only by transferring patients to wards or into surgery. That flow—from ambulance to emergency department to ward and, hopefully, to home and recovery—simply is not happening, because beds are not being cleared.”

As reported in the Echo, South Western Ambulance Service (SWAS) NHS Foundation Trust was given an overall rating of 'requires improvement' by the Care Quality Commission (CQC) earlier this month, with concerns expressed over staff shortages, training and the reporting of problems.

Inspectors found "good organisation and distribution of staff and services", and in the 19 months until January 2016 the trust was better than the national average for responding within eight minutes to Red I calls - calls to the service which were immediately life threatening such as cardiac arrest.

However, they found "staff morale and motivation was mixed" with a "significant" proportion of front line ambulance staff saying they "felt unwell due to work-related stress or had experienced musculoskeletal problems as a result of work activities".

SWAST is currently taking part in a trial to try and improve the practice of trusts throughout the country.

As part of this trial, a number of issues have been identified.

These are:

 Dispatching resources to a 999 call, on blue lights and sirens, before it has been

determined what the problem is and whether an ambulance is actually required;

 Dispatching multiple ambulance vehicles to the same patient, on blue lights and sirens

and then standing down vehicles least likely to arrive first;

 Diverting ambulance vehicles from one call to another repeatedly;

 Using a ‘fast response unit’ to ‘stop the clock’, when this provides limited clinical value to a patient, who then waits for a conveying ambulance;

 Very long waits for lower priority calls that nevertheless need assessment and conveyance to hospital.

Between five per cent  and 6 per cent of all incidents received by SWASFT during the trial period to date are identified as Red incidents. This equates to between 110 and 120 Red incidents per day across the South West.

This compares to an average of 50 Red 1 incidents per day and 860 Red 2 incidents per day across SWASFT in 2015/16.

Have you had a long wait for an ambulance or a long wait at A&E? Contact the newsdesk

RESPONSE FROM SWAS

Many people incorrectly think that if they dial 999 and ask for the ambulance service an ambulance will be dispatched and they will be taken to hospital. The majority of incidents the Trust deals with are closed without the need to convey [take] a patient to an emergency department at a hospital.  SWASFT is the best performing ambulance service for non-conveyance rates – this may seem strange as a ‘best performing’ figure, but this is better for patients and most patients want to be treated outside a hospital setting wherever possible.

 Approximately one in eight calls to our 999 service are treated over the telephone.  Hear and treat accounts for 12.7% of calls and means the patient receives clinical advice over the telephone.  36.4% of patients experience see and treat, when the patient receives treatment or advice at the scene of the incident.  A further 7.7% of patients are taken to a non-hospital department so that might mean a community hospital or minor injuries unit.  The rest are taken to a hospital emergency department, or 56.8% are not conveyed.  An additional figure to be aware of is that approximately 62% of patients taken to hospital are admitted – this is again the highest (best) performance for an ambulance trust in the country.  This means that when SWASFT takes a patient to an emergency department they are likely to be admitted, not simply treated and discharged, therefore confirming that is the right place for them to receive the care they need.

A South Western Ambulance Service spokesman said: “Ambulances queuing to handover patients at hospital emergency departments are not available to respond to other patients in need. South Western Ambulance Service NHS Foundation Trust (SWASFT) works hard with the 18 acute hospitals in the South West to minimise handover delays in their emergency departments (EDs).

“SWASFT also works closely with its commissioners to ensure a collaborative approach to managing pressures on delivering high quality emergency care. Handover delays are reported to clinical commissioning groups (CCGs) and reviewed on a monthly basis.

“SWASFT is one the best performing ambulance trusts in the country for minimising handover delays. Increasing demand year-on-year is putting pressure on every area of the NHS and we pride ourselves on ensuring our patients are cared for in the right setting.

"SWASFT is also the top performing ambulance service for the number of patients not conveyed to an emergency department, where possible and appropriate. On average, more than 50% of our patients are treated via other, more appropriate, care pathways within the community, either over the telephone or face-to-face, without needing to attend an emergency department."